Department of Orthopedics, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2022 Jun;14(2):184-190. doi: 10.4055/cios21042. Epub 2022 Apr 15.
The current trend of using short femoral stems in total hip arthroplasty (THA) is associated with angular deviation of the femoral stem towards the native femoral axis. The purpose of this study was to compare the difference in stem tilt angle between two different stems with a similar design except for the stem length.
This is a retrospective review of 66 patients who underwent primary THA between April 2012 and May 2016, using a trans-gluteal direct lateral approach by a single surgeon. We evaluated the femoral stem tilt angle in both the coronal and sagittal planes and performed multivariate logistic regression analysis to evaluate possible risk factors. We also simulated the range of motion (ROM) of the hip joint using three-dimensional computer-aided design software (SolidWorks, 2016) to examine the clinical significance of femoral stem tilt.
The mean coronal tilt angle was 1.8° ± 1.0° in the conventional stem group and 1.6° ± 1.1° in the short stem group, showing no statistically significant difference between the groups ( = 0.570). However, the mean sagittal tilt angle was 4.0° ± 2.0° in the conventional stem group and 7.8° ± 2.0° in the short stem group ( < 0.001). The stem type and stem length had a linear correlation with the sagittal tilt angle ( < 0.001) in multivariate regression analysis. A simulated hip ROM demonstrated a 3.8° decrease in extension in proportion to a 3.8° increase in the mean sagittal stem tilt angle of the short femoral stem.
Anterior femoral stem tilting in the sagittal plane was prominent when the shorter stem was used, and anterior tilting was responsible for decreased ROM in hip extension.
在全髋关节置换术（THA）中使用短股骨柄的当前趋势与股骨柄向原生股骨轴的角度偏差有关。本研究的目的是比较两种不同设计的股骨柄在除柄长外其他方面相同的情况下，其柄倾斜角度的差异。
这是一项回顾性研究，纳入了 2012 年 4 月至 2016 年 5 月期间由同一位外科医生采用经臀肌直接侧方入路行初次 THA 的 66 例患者。我们评估了冠状面和矢状面的股骨柄倾斜角，并进行多元逻辑回归分析以评估可能的危险因素。我们还使用三维计算机辅助设计软件（SolidWorks，2016 年）模拟髋关节的活动范围（ROM），以检查股骨柄倾斜的临床意义。
在常规柄组，冠状面倾斜角的平均值为 1.8°±1.0°，在短柄组为 1.6°±1.1°，两组间无统计学差异（ = 0.570）。然而，在常规柄组，矢状面倾斜角的平均值为 4.0°±2.0°，在短柄组为 7.8°±2.0°（<0.001）。多元回归分析显示，柄类型和柄长度与矢状面倾斜角呈线性相关（<0.001）。模拟髋关节 ROM 显示，短股骨柄的矢状面平均倾斜角度增加 3.8°，髋关节伸展活动度减少 3.8°。
当使用较短的股骨柄时，股骨柄在矢状面上的前倾斜明显，前倾斜导致髋关节伸展活动度减少。
